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Country Doctor Achieves the Triple Aim

Advocates of health care reform like to talk about something called the Triple Aim – the possibility of increasing access to medical care, lowering the cost and improving the quality. 

It’s a tall order, but one doctor in rural Virginia seems to have proven it’s possible. 

Dr. Rob Marsh loves what he does – especially when it involves four-month-old twins Savannah and Brentley Groah.

“She napping well during the day?  Some days she doesn’t, and some days she’s up all day long. Who’s the boss of the two?  She is?”

They were born prematurely – weighing just over four pounds, but now both are doing well.  Marsh gives credit where credit is due.

“Mom’s done a great job.” 

And mom gives credit to Marsh, as do many of his patients in Virginia’s Shenandoah Valley.  For one thing, says 51-year-old John Almarode, he’s available.

“He’s so thorough -- catches a lot of stuff other doctors don’t catch + and have you ever had to call him after hours?  He answers his cellphone on Christmas Day.” 

Almarode had the flu, so Marsh arranged to meet him at the office. That was not something he could do in his previous job – working for a major university’s medical center.

“It was hard to open up the office after hours.  That’s just something you don’t do, but in a rural area it did.  My philosophy has always been the patient is first, and I really enjoy the personal relationship I have with my patients, because quite frankly in a small town your patients are your neighbors and your friends.”

He’s able to charge relatively low rates, in part because he finished medical school with no debts.  His training was paid for by the U.S. Army, which does not require students to specialize early in their education.

“The army’s way is you go do a general internship, and then after serving in the field for one or two years you come back and do your specialty care.  I stayed out seven years.  I loved what I was doing, and then it was after Desert Storm that I realized I’m doing family medicine.  I don’t think I would have be ready for that right out of medical school.”

Marsh also keeps costs down by relying on a team of medical professionals who cost less than doctors. When he opened his practice, he had one nurse and one medical assistant.  Today, he has 23 people in his practice, all providing parts of patient care they’re qualified to perform.

“Hi, this is Sherrie from Dr. Marsh’s office.”

Sherrie Fravel is a medical assistant.

“I’m returning your call. If you hang on a minute, I’ll put Dr. Marsh on the phone.  Is this a convenient time? “

And, finally, Marsh opened a second office to serve more patients while assuring that all can afford the care they get.

“A few years ago, Mr. Berkstresser, the owner of White’s truck stop, came to me and asked if I would be interested in opening an office at his facility, and at first my instinct was, ‘I’m busy enough now.  No!  But then as I looked it, I realized this may be a good source of additional income for us, so that if I don’t want to charge somebody else, I can do that from doing physicals and health exams on truck drivers.”

So back to the Triple Aim:  Increased access?  Check.  Lower costs?  Check.  He doesn’t have data to support a claim of improved quality, but talk with patients like Duane Caricofe, and you definitely get the feeling quality is good.

“They always take time to talk to you, explain what’s going on and it’s terrific.  I spent last weekend in the hospital, and he called several times to check and touch base and see what was going on, so it made me feel like he knew what he was doing.”

He even makes house calls, accepting nothing more than a piece of pie when offered, and one more indication of how well this practice works – Marsh was named Country Doctor of the Year by a trade group that honors the spirit, skill and dedication of physicians practicing in communities of 30,000 or less. 

Sandy Hausman is Radio IQ's Charlottesville Bureau Chief
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